Re P (Application for Secure Accommodation Order)
| Jurisdiction | England & Wales |
| Judge | Judge Bellamy |
| Judgment Date | 12 October 2015 |
| Neutral Citation | [2015] EWHC 2971 (Fam) |
| Court | Family Division |
| Date | 12 October 2015 |
[2015] EWHC 2971 (Fam)
IN THE FAMILY COURT
His Honour Judge Clifford Bellamy Sitting as a Deputy High Court Judge
Miss Amanda Cranny for the local authority
Miss Claire Howell for the child
The mother appeared in person
P is now just over 16 years of age. With the consent of her mother she has been accommodated under s.20 of the Children act 1989 since October 2013. In February 2014 the local authority issued care proceedings. At the final hearing of the care proceedings I concluded that P's best welfare interests required that she be made a ward of court. An issue now arises concerning the arrangements for her present care. The local authority has applied to the court for a secure accommodation order. There is an issue as to the court's power to make a secure accommodation order given that the application was issued shortly after P's 16 th birthday. This judgment relates to that issue.
Since issuing the application for a secure accommodation order P has been compulsorily detained under s.3 of the Mental Health Act 1983. With the consent of the parties the application for a secure accommodation order has been adjourned generally with liberty to restore. For reasons which will become clear later in this judgment, the local authority remains concerned that it may in due course find itself in a position in which it considers it necessary to proceed with the application for a secure accommodation order as a matter of urgency. I agreed, therefore, to address the issue of jurisdiction at this stage.
Background
In 2013 P telephoned Child Line stating that she wanted to harm herself and was thinking of ways to end her life. That telephone call led to the beginning of multi-agency involvement with P and her family. Over the course of the next six months P's behaviours included frequent self-harming, threats to kill herself and running away from home. Following the mother's agreement to P being accommodated by the local authority, P was placed with foster carers.
In December 2013 P said that she had taken an overdose of Ibuprofen. She also said that she was hearing voices. She was taken to hospital. She was seen by a psychiatrist and by Child and Adolescent Mental Health Services ('CAMHS'). She remained in her local hospital until a specialist bed became available. As there were no specialist beds available locally she was placed in a unit more than 100 miles from her home. She was admitted as a voluntary patient.
P's behaviours continued whilst in hospital. She made further attempts to self-harm. She refused to eat. In January 2014 she was detained under s.2 of the Mental Health Act 1983. In February, she was detained under s.3. In July 2014 she applied to a Tribunal to be discharged from her section. Her application was refused.
During the course of the care proceedings the court gave permission for an assessment of P by Dr R, a Consultant Child and Adolescent Psychiatrist. In her report, Dr R said that P presents
'with complex multiple psychopathology which seriously impact on her day to day functioning…P presents with multiple comorbidity. Whilst this clusters into a number of diagnostic groups of emotional disorders (obsessive-compulsive disorder, anxiety disorders, recurrent depressive disorder) and psychotic disorders, most of them do not reach formal diagnostic criteria. The cumulative impact on P's emotional and social functioning on a day to day basis is however significant and very impairing indeed. He psychosocial disability as a result is moderate to severe…There are at this stage two clusters that are more convincing in terms of diagnostic validity. These are emerging borderline personality disorder (a form of an emotionally unstable personality disorder) and post-traumatic stress disorder.'
In the context of recent events it is also appropriate to note Dr R's explanation of the features of emerging borderline personality disorder. These comprise,
'a pattern of marked impulsivity and instability of affect, interpersonal relationships and self-image. The pattern is present by early adulthood, usually emerges in adolescence, and occurs across a variety of situations and contexts. Because a personality disorder is a pervasive, enduring and inflexible pattern of maladaptive inner experiences and pathological behaviour, there is a general reluctance to diagnose personality disorders before adolescence or early adulthood. However, without early treatment symptoms may worsen. Hence early recognition of this pattern is very important.'
The final hearing of the local authority's application for a care order came before me in August 2014. The mother's consent to P being accommodated under s.20 remained in place. I concluded that P's welfare interests would be best served by her being made a ward of court rather than being made the subject of a final care order. In light of the decision of the Court of Appeal in Re E (Wardship Order: Child in Voluntary Accommodation) [2012] EWCA Civ 1773 I was satisfied that I had the power to proceed in that way.
In September 2014 P was transferred to a specialist less secure unit closer to her home. That move was short-lived. Concerns about P's behaviour led to her being transferred to a more secure unit. P made progress. In February 2015 she was transferred to a 'step-down' facility with a view to her ultimate discharge from hospital. The next month she was discharged from her section but remained in hospital as a voluntary patient. Plans were made for her ultimate discharge from hospital.
In June P was discharged into a therapeutic community placement. She continued to self-harm. She also ran away from her placement. There was a significant deterioration in her behaviour in August.
Recent history
On 19 th August P self-harmed by cutting her arms. On 20 th August she inserted the inner tube and nib of a biro into her arm. She was admitted to Hospital A. Whilst in hospital she attempted to make ligatures. She was placed on 1:1 round the clock supervision.
On 21 st August, following an assessment by CAMHS, P was discharged back to her community placement. Hospital A did not inform the local authority of its intention to discharge P back to her placement. The community placement was not able to provide the same level of round the clock supervision.
Three days later, on 24 th August, P swallowed two AA batteries. She was re-admitted to Hospital A. The next day she was transferred to a Children's Hospital (Hospital B). She was admitted to a surgical ward. The treating clinicians decided that there was no urgent need to operate to remove the biro. The AA batteries were finding their own way out of P's system.
On 31 st August, whilst still a patient at Hospital B, P again swallowed 2 batteries, despite then being on 2:1 supervision paid for by the local authority. P also self-reported that she had inserted a piece of plastic into her leg.
On 1 st September P absconded from the hospital. She was soon found and brought back to the ward.
Although she remained on a surgical ward, P was also under the care of a locum Consultant Child & Adolescent Psychiatrist, Dr Z. The question arose about whether P should again be compulsorily detained under s.3 of the Mental Health Act. It was Dr Z's opinion that detention under s.3 was not appropriate. In a written report dated 2 nd September Dr Z said that,
'1. P is currently on an adequate pharmacological treatment for her Post Traumatic Stress Disorder symptoms.
2. There is no evidence of a serious and enduring mental disorder and as P has been extensively assessed by mental health services, and as if admitted to a mental health bed she is likely to learn further self-harm strategies, and this will prevent her from acquiring the cognitive and social skills necessary to be able to function as an adolescent, I am not recommending another admission to an inpatient mental health bed.
3. In my opinion P requires a long term placement with the capacity to offer a secure environment that could prevent her from absconding and could offer one to one supervision 24 hours a day for periods of time, in which P could access education and therapy. P is a vulnerable young person and due to the risk of absconding, when she is likely to suffer significant harm or injure herself, I would recommend that the Court considers a Secure Accommodation Order (Section 25 of the Children's Act 1999 (sic)) for P.'
The local authority sought a hearing before the court. I re-appointed P's children's guardian from the care proceedings. On 3 rd September I heard from counsel for the local authority and for the guardian. I was concerned about the views expressed by Dr Z. I therefore listed the matter for further hearing on 8 th September and directed that Dr Z should attend.
Dr Z gave evidence at the hearing on 8 th September. His position remained unchanged. He accepted that the risk of further self-injurious behaviour was high. However, in his opinion P was not suffering from either an acute or an enduring mental illness. He was unable to identify any mental disorder. In his opinion P did not require compulsory admission to hospital under the Mental Health Act. I was left with the impression that the real problem was to do with the scarcity of CAMHS Tier 4 inpatient beds and that that was the reason why it was being proposed that P be diverted into secure accommodation.
Though not convinced that a secure accommodation order was appropriate, the local authority made strenuous attempts to find a secure accommodation placement for P. More than 50 units were approached. The search was unsuccessful.
The matter came back before me on 11 th September. By then the local authority had identified a placement for P which appeared able to provide...
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